Unilateral Accessory Articular Facet at C1 to C2

In 2011, a unilateral accessory C1 to C2 articular facet was described for the first time. We report an uncommon case of a right-sided accessory C1 to C2 articular facet causing cervical spinal cord compression. A 41-year-old man presented with neck pain radiating to the trapezius muscles for 8 months. Two months later, he developed impaired fine motor skills. Physical examination revealed tenderness on palpation of the cervical paravertebral muscles, more pronounced on the right side. Cervical imaging studies demonstrated a right-sided accessory C1 to C2 facet causing significant compression of the cervical spinal cord. The patient underwent a right-sided C2 laminectomy followed by complete arthrectomy of the compressive accessory facet using a bone cutter to achieve spinal cord decompression. At outpatient follow-up 2 months after surgery, he showed complete resolution of the fine motor impairment. This case highlights the importance of considering atypical anatomical causes in the differential diagnosis of common spinal symptoms, such as neck pain, and contributes additional information on a spinal pathology that remains poorly represented in the literature.